Inside the Internal Discipline of Leadership: Culture, Responsibility, and Values in Practice, featuring Stu Clark, CEO, Premise Health

Stu Clark, CEO of Premise Health, joined The Nashville Health Care Council for our executive briefing, moderated by James Porter, VP Provider Partnerships, Monogram Health which focused on the internal discipline of leadership, the responsibility leaders carry, the culture they shape, and the values that anchor them when pressure hits.

He began with accountability. At Premise, while they operate a direct healthcare model serving major employers, he made clear that he ultimately views himself as responsible to the pensioners whose retirement capital backs the company. That stewardship mindset drives how he thinks about growth, risk, and performance. Leadership, in his view, starts with knowing exactly who you serve and remembering that responsibility daily.

Culture was a major theme. Stu described himself as deeply committed to culture, but not in a superficial way. At Premise, leadership behavior is non-negotiable and built around a clear order of priorities:

• Mission first
• Team second
• The individual teammate third
• Self last

If that order is accidentally disrupted, it’s corrected. If it’s deliberately reversed and ego takes over, there are consequences. He believes humble, aligned teams consistently outperform organizations driven by individual ambition.

He was candid about his own struggle with imposter syndrome, particularly during high-growth years when the stakes were elevated. In his view, any leader who says they haven’t experienced imposter syndrome is either lying to you or lying to themselves. The issue isn’t whether it shows up, it will. The issue is how you respond to it.

He emphasized that you have to find ways to address it because, ultimately, as a leader, you are required to exhibit confidence, and confidence is not something you can fake. To genuinely project confidence, you first have to come to terms with your insecurities.

What helped him was adopting a disciplined way of thinking: if it’s manmade, you can understand it, as long as you keep unpacking it. When faced with complexity, unfamiliar terminology, or high-stakes decisions, he committed to asking questions and tearing issues apart until he truly understood them. Much of imposter syndrome, he noted, comes from trying to interpret what’s happening around you without fully grasping it. By breaking things down to their fundamentals and refusing to be intimidated by complexity, he replaced uncertainty with clarity and clarity built real confidence.

He also spoke about a pivotal early-career transition that forced him to reset and clearly define what he stood for. That season became foundational in shaping his personal ethos, the principles he would anchor to regardless of circumstance. He encouraged leaders to intentionally develop their own code, something steady enough to hold onto when pressure, insecurity, or outside influence threatens to pull you off course. Without that anchor, leaders drift.

He also outlined common leadership temptations he believes derail teams:

• Making leadership about personal validation or popularity
• Demanding harmony instead of inviting healthy conflict
• Delaying decisions in pursuit of perfect information
• Refusing to pivot when wrong
• Surrounding yourself with people who won’t challenge you

Strong leadership, he said, requires welcoming disagreement, making timely decisions, and course-correcting quickly when necessary.

Another consistent thread was belief, in the mission, in the team, and in the possibility of finding a way forward. Through examples from history, endurance athletes, and his own experience navigating COVID, he illustrated how belief often separates those who endure and succeed from those who stall. When the company’s on-site model was threatened during the pandemic, the response wasn’t retreat, it was adaptation. They made a way.

His interest in classical history ties into this philosophy. He believes leadership challenges are not new. Human nature, insecurity, pride, resilience, fear, ambition, hasn’t changed in thousands of years. The lessons leaders need already exist; the responsibility is to study them, understand them, and apply them.

Ultimately, Stu’s message was direct: leadership is ownership. If your team is misaligned, disengaged, or underperforming, it rests with the leader. Build your ethos. Put the mission and team ahead of yourself. Expect to wrestle with insecurity. Invite challenge. Decide and adjust. And above all, choose discipline and belief over ego.